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~. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lafarge West, Inc. <br />M-1982-147 <br />Nyholt Pit (aka Mann) <br />Apri120, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Adams <br />REC~6V~D <br />APR 161004 <br />Uwisluo of Mircrcra ~, GeolaeY <br />According.to C:R.S._34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of curent disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written anneal report and anneal report man to this form. Please note that an <br />adequately labeled map that clearly delineates and inchrdes the above elements may since far a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Reckentine <br />Permittee Name: Lafarge West, Inc. <br />Address: 1400 W. 64th Ave. <br />Denver, CO 80221 <br />Phone Number: (303) 657-4330 <br />Fax Number: (303) 657-4339 <br />` \~`J <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of C,~/o7rporate Officner`, Oow/ner, or Designee <br />1 .V ~ ~ ~C./.~Y/ <br />Date r <br />